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NPI Code Detail

MEDICARE: MARK DAVID FAY P.T.

MEDICARE: MARK DAVID FAY P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist04438LA
22251X0800XOrthopedic Physical TherapistPT23874FL
3225100000XPhysical TherapistPT23874FL

General Provider Information

NPI Number : 1750320172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK DAVID FAY P.T.
Provider Business Mailing Address
First Line : 465 TOWN PLAZA AVE
Second Line : SUITE B
City : PONTE VEDRA
State : FL
Zip : 32081
Country : US
Telephone Number : 904-222-3780
Fax Number :
Provider Business Practice Location Address
First Line : 465 TOWN PLAZA AVE STE B
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-5190
Country : US
Telephone Number : 904-222-3780
Fax Number : 904-306-5772
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 05/15/2025

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